Texas faces critical shortage of primary-care providers

By BILL HAMMOND

Published 5:05 pm, Monday, December 19, 2011

If you have a primary-care provider, you are one of the lucky ones. If you are looking for one, good luck. They are becoming harder to find because Texas has a severe shortage of primary-care providers, and the problem will only get worse unless the state does something to remedy the situation.

Texas needs thousands of primary-care providers over the coming years to ensure that its fast-growing, underserved population has access to basic health care and doesn't end up going someplace far more expensive for treatment, such as an emergency room.

Texas faces a shortage of primary-care doctors for several reasons. One is the Patient Protection and Affordable Care Act. As a result of the act, starting in 2014 the demand for health care will go up because more and more people will be eligible for the Medicaid program. Supply will not keep up with that demand.

Another contributing factor is that doctors are being forced to leave the state to complete their residency training. Texas is far behind states with similar populations when it comes to its number of residency programs.

Studies show that the majority of doctors set up their practice in the state where they complete their residency. That means we must keep those doctors here. Creating more residency programs is critical.

You would think that increasing the number of medical schools would help, but that isn't what is needed. In fact, looking at the monetary side of the issue, we should reduce the number of slots at medical schools. Given the fiscal reality that the state faces, the money saved by reducing the number of medical school slots should be used to pay for an increased number of residency slots. Without enough residency slots, we are wasting taxpayers' money by paying for part of these doctors' training, and then watching them leave the state to do their residency programs and most likely not come back to Texas.

There are some other legislative alternatives too. Allow nurse practitioners and physician assistants to provide primary care and reduce restrictions on those practices. We could also allow all hospitals to directly employ doctors and other health care providers, and expand the use of telemedicine, especially in rural areas.

We should also utilize the skills of our military returning from Iraq and Afghanistan. We should recruit those field medics into our nursing and other medical programs and come up with streamlined training that builds on the skills they already have. That would be a huge step in the right direction.

We must also reduce the cost of medical training overall. Lawmakers and the Higher Education Coordinating Board need to work together to not only find ways to reduce the cost of training, but also develop a seamless six-year program to take students from Bachelors of Science degrees to medical degrees.

The Legislature took some big steps forward a few years ago by reforming the state's medical malpractice laws, which helped bring in new and much needed specialists. It's time for lawmakers and higher education officials to take these next logical steps, or we will all suffer in the long run.